Surgery for Salivary Gland Cancer

Surgery is often the main treatment for salivary gland cancers. Your cancer will probably be treated with surgery if the doctor believes that he or she can remove it completely. (That is, if the cancer is resectable.) Whether or not a cancer is resectable depends largely on how far it has grown into nearby structures, but it also depends on the skill and experience of the surgeon. Being treated by a surgeon who has treated many patients with salivary gland cancer gives you the best chance of having your cancer removed completely. This, in turn, gives you the best chance of being cured.

In most cases, the cancer and some or all of the surrounding salivary gland will be removed. Nearby soft tissue may be taken out too. The goal is to have no cancer cells in the outside edges (margin) of the removed tumor. If the cancer is high grade (more likely to grow and spread quickly) or if it has already spread to lymph nodes, t lymph nodes from the same side of the neck may be removed in an operation called a neck dissection (described below).

Before surgery, ask your surgeon exactly what will be done during the operation, what the goals of the surgery are, whether there are other options, whether surgery will change the way you look or the way your body works, and what side effects you can expect.

Types of surgery for salivary gland cancer

The type of surgery will depend on which salivary gland is affected.

Parotid gland surgery

Most salivary gland tumors occur in the parotid gland. Surgery here is complicated by the fact that the facial nerve, which controls movement on the same side of the face, passes through the gland. For these operations, an incision (cut) is made in the skin in front of the ear and may extend down to the neck.

Most parotid gland cancers start in the outside part of the gland, called the superficial lobe. These can be treated by removing only this lobe, which is called a superficial parotidectomy. This usually leaves the facial nerve intact and does not affect facial movement.

If your cancer has spread into deeper tissues, the surgeon will remove the entire gland. This operation is called a total parotidectomy. If the cancer has grown into the facial nerve, it will have to be removed as well. If your surgeon has mentioned this surgery as a possibility, ask what can be done to repair the nerve and ways to treat side effects caused by removing the nerve. If the cancer has grown into other tissues near your parotid gland, these tissues might also need to be removed.

Submandibular or sublingual gland surgery

If your cancer is in the submandibular or sublingual glands, the surgeon will make a cut in the skin to remove the entire gland and perhaps some of the surrounding tissue or bone. Nerves that pass through or near these glands control movement of the tongue and the lower half of the face, as well as sensation and taste. Depending on the size and location of the cancer, the surgeon may need to remove some of these nerves.

Minor salivary gland surgery

Minor salivary gland cancers can occur in your lips, tongue, palate (roof of the mouth), mouth, throat, voice box (larynx), nose, and sinuses. The surgeon usually removes some surrounding tissue along with the cancer. The exact details of surgery depend on the size and location of the cancer.

Possible risks and side effects of salivary gland surgery

All surgery has some risks, including complications from anesthesia, bleeding, blood clots, and infections. These risks are generally low but are higher with more complicated operations.

For any salivary gland cancer surgery, the surgeon may need to cut through your skin or cut inside your mouth. Most people will have some pain afterwards , but this can usually be controlled with medicines.

If your facial nerve is damaged during surgery, you might lose control of your facial muscles on the side where the surgery was done. That side of your face may droop. If the injury to the facial nerve is related to retraction (pulling) of the nerve during surgery and/or swelling from the operation, the damage might heal over time.

Sometimes, nerves cut during surgery grow back abnormally and become connected to the sweat glands of the face. This condition, called Frey syndrome or gustatory sweating, results in flushing or sweating over areas of your face when you chew. Frey syndrome can be treated with medicines or with additional surgery.

Damage to other nerves in the face or mouth might cause problems with tongue movement, speech, or swallowing.

Depending on the extent of the operation, your appearance may be changed as a result of surgery. This can range from a simple scar on the side of the face or neck to more extensive changes if nerves, parts of bones, or other structures need to be removed.

It’s important to talk with your doctor before the surgery about what changes in appearance or other side effects you might expect. This can help you prepare for them. Your doctor can also give you an idea about what corrective options might be available afterward, such as skin grafts, nerve grafts, and reconstructive surgery.

Lymph node removal (neck dissection)

Surgery to remove lymph nodes is called a lymph node dissection or lymphadenectomy. Salivary gland cancers sometimes spread to lymph nodes in the neck (cervical lymph nodes), and these may need to be removed as a part of treating the cancer. This is called a neck dissection.

A neck dissection may be done if:

Lymph nodes in the neck are enlarged (which may be felt or seen on a CT or MRI scan)

The cancer is high grade (looks very abnormal under the microscope) or has other features that mean it has a high risk of spreading

The removed lymph nodes are looked at under the microscope to see if they contain cancer cells. Taking out the lymph nodes can help ensure all of the cancer is removed. It can also be important for staging and deciding if more treatment is needed.

There are many types of neck dissections, but their major purpose is to remove lymph nodes that might contain cancer. In doing this, the surgeon may need to remove nearby connective tissue, muscles, nerves, and blood vessels from one side of your neck. This type of surgery is usually done through an incision (cut) across the side of the neck, but sometimes a longer incision going down the neck might be needed.

Possible risks and side effects of lymph node removal

The general risks of a neck dissection are much like those with any other type of surgery, including problems with anesthesia, bleeding, blood clots, infections, and poor wound healing. Most people will have some pain afterwards , but this can usually be controlled with pain medicines.

Because this surgery can affect nerves that run through the neck, it can sometimes lead to ear numbness, weakness in raising your arm above your head, and weakness of the lower lip. These may get better with time. You can be helped by physical therapists who can teach you exercises to improve your neck and shoulder movement.

Sentinel lymph node biopsy

Sentinel lymph node mapping and biopsy has become a common way to find out whether a cancer has spread to the lymph nodes. It may be used in certain types of salivary gland cancer, and can help keep you from needing neck dissection. This procedure can find the lymph nodes that drain lymph fluid from the salivary gland where the cancer started. These lymph nodes are usually the first place cancer will go. The surgery involves taking out these lymph nodes and checking them for cancer during the surgery. If no cancer cells are found, the other lymph nodes can be left alone. If these nodes do have cancer cells in them, neck dissection is usually needed.